Insulin- and glucagon-like peptide-1-induced changes in heart rate and vagosympathetic activity: why they matter

Abstract

Heart rate (HR) predicts cardiovascular morbidity and mortality in individuals either with or without diabetes. In type 2 diabetic patients, cardiac autonomic neuropathy is a risk marker for cardiac morbidity and mortality. A major pathogenic potential may be attributed to vagal depression and sympathetic predominance. In this issue of Diabetologia, Berkelaar et al

Exenatide acutely increases heart rate in parallel with augmented sympathetic nervous system activation in healthy overweight males

“…As exenatide increased HR and SBP without effects on TPR, our data suggest that exenatide acts on these variables through SNS activation. This premise was underlined by concomitant increases in RPP and LF : HF ratio . Furthermore, as exenatide left TPR and DBP unaltered in the present study, the reflex tachycardia hypothesis seems to be refutable, and moreover suggest that SNS activation does not result from baroreceptor reflex activity.…”

“…A 30 s average was derived using dedicated software (Nexfin@PC version 2, BMEYE, Amsterdam, the Netherlands). The rate-pressure product (RPP), a marker reflecting sympathetic nervous system (SNS) activity, was calculated as HR × SBP [7].…”

Are Obese Individuals with no Feature of Metabolic Syndrome but Increased Waist Circumference Really Healthy? A Cross Sectional Study

“…The defect in vagal activity and the subsequent sympathetic predominance might also contribute to alter metabolic parameters. As recently reviewed (Valensi et al, 2013), this is supported by the elevated sympathetic activity and depressed vagal activity in subjects with metabolic syndrome. Furthermore, a longitudinal study showed that the progression to type 2 diabetes was associated with increased central sympathetic drive, blunted sympathetic responsiveness, and altered norepinephrine disposition.…”

“…Our MHO patients with cardiac autonomic dysfunction had slightly higher total cholesterol and HbA1c levels than those without, suggesting that cardiac autonomic dysfunction might be involved in more marked metabolic changes such as those found in MUO patients. As to the mechanisms leading to cardiac autonomic dysfunction in obese individuals, several factors such as changes in insulin, C-peptide, leptin, adiponectin, GLP-1 and free fatty acids were shown to be able to acutely induce changes in the autonomic nervous system activity (for review (Valensi et al, 2013)). Fasting and post oral glucose challenge insulin levels did not differ in our MHO patients with or without cardiac autonomic dysfunction.…”

Optimising cardioprotection during myocardial ischaemia: targeting potential intracellular pathways with glucagon-like peptide-1

“…Heart rate increase is predictive of adverse cardiac morbidity and mortality and is therefore undesirable [78]. A meta-analysis found a small heart rate increase of 1.86 beats per minute with GLP-1 receptor agonists exenatide and liraglutide compared with placebo [79].…”